Tobacco still kills 6m people around the world every year. Despite huge public health efforts to help people quit and prevent young people starting, smoking remains the single greatest cause of ill health and premature death. And even with restrictions on tobacco advertising and smoking in public places, many young people continue to take up smoking. The situation is even worse in poorer countries, where support to stop smoking is limited, and tobacco control policies weaker.

The gadgets deliver a nicotine hit by heating a nicotine-containing propylene glycol (e-liquid) to create an aerosol (usually called “vapour”), which is inhaled. Put simply, they deliver nicotine almost as effectively as a conventional cigarette, but without the vast majority of other chemicals present in tobacco smoke (either from the tobacco itself, or as a result of the burning process).

A whole culture is emerging around “vaping”. Many devices offer a range of power settings, and a vast array of e-liquids is on offer, with varying nicotine contents and flavours. Enthusiasts often apply modifications to their devices, and engage in “cloud chasing” – competing to produce the largest and most interesting clouds of vapour. And yes, young people are experimenting with e-cigarettes (in the same way that they have always experimented with pretty much everything), although at the moment there is no strong evidence this is leading to subsequent cigarette use, or even long-term e-cigarette use.

The rapid growth in use of e-cigarettes, especially among smokers trying to cut down or quit, has taken the public health community and the tobacco industry by surprise. Both are struggling to catch up. Health professionals are hurrying to carry out research to develop evidence-based guidelines and policies. Meanwhile, the tobacco industry is buying up e-cigarette companies and introducing its own products onto the market.

So how concerned should we be about this emerging and disruptive technology?

Should we encourage existing smokers to use e-cigarettes to help them stop smoking, even if this means they continue using nicotine long-term? In the United Kingdom there is some consensus that smokers should be encouraged to use e-cigarettes if they feel they might help, and the National Centre for Smoking Cessation and Training is supportive of their use. Part of the reason many vapers feel so passionately about the subject (and react strongly when they feel that vaping is being unfairly attacked) is that for the first time, through the use of e-cigarettes, they have felt able to take control of their nicotine habit, stop smoking, and reassert some control over their health, without being medicalised in the process.

But a problem remains in the lack of information on the possible harm of e-cigarettes. This is unlikely to change any time soon, since the health effects of tobacco use can take several decades to emerge, and it’s probable the same will be true for e-cigarettes. Nothing is entirely risk-free, but the vastly reduced number of chemicals present in e-cigarette vapour compared to tobacco smoke means we can be confident that vaping will be much, much less harmful than smoking.

Heartening evidence

As part of the investigation into the effects of e-cigarettes, we investigated how the cells found in the arteries of the heart, known as human coronary artery endothelial cells, responded when they were exposed to both e-cigarette vapour and conventional cigarette smoke. We found the cells showed a clear stress response from the cigarette smoke, but not from the electronic cigarette. This suggests tobacco smokers may be able to reduce immediate tobacco-related harm by switching from conventional cigarettes to e-cigarettes.

Many people find it difficult to function without their first caffeine hit of the day. But no one is seriously calling for coffee shops to be dismantled or regulated. Nicotine is addictive, but much less so on its own than in tobacco, where other chemicals enhance its effect. At the doses consumed by vapers the harm is likely to be very low (although we need to continue to research this), and many vapers actually gradually move to zero nicotine content e-liquids, even while continuing to vape.

Of course, we may end up with a large population of long-term nicotine users who use e-cigarettes to deliver nicotine rather than cigarettes, but all of the evidence at the moment suggests that this population will almost entirely comprise ex-smokers. This would produce a vast public health gain.

We must be careful not to restrict smokers’ access to e-cigarettes, or over-state the potential harm of their use, if this will put people off making the transition from smoking to vaping. To do so would deny us one of the greatest public health improving opportunities of the last 50 years.

Susan Michie, Professor of Health Psychology and her team at UCL, have developed a new type of app to tackle excessive alcohol consumption, a major societal and public health challenge.

This is the first app that uses evidence and theory from the fields of behavioural science and addiction to help support users in reducing their alcohol consumption.

Drink Less is a super-easy to use app that allows you to keep track of how much you drink, set goals to drink less, get feedback on whether what you’re doing is working and access some unique and fun ways of changing your attitude towards alcohol. Try it here!

You can:
– Keep track of your drinking and see how it changes over time
– Set goals for the targets that matter to you and get feedback on your progress towards them
– Complete a daily mood diary so you can better understand the effects of your hangover
– Play games designed to strengthen your resolve to drink less alcohol
– Create plans for dealing with situations when you may be tempted to drink excessively
– Take part in exercises designed to change your relationship with alcohol

Screenshot of the app in action.

Easy to select beverage options and view your progress.

Drink Less has been created by a team of psychologists at University College London; who’re researching what techniques help people reduce their consumption of alcohol. You can use the app fully without taking part in the study and you can opt-out of it at any time. But if you do participate you’ll be helping understand how to help more people drink less.

1.1 million children – almost half of all children in poverty – were estimated to be living in poverty with at least one parent who smokes; and a further 400,000 would be classed as being in poverty if parental tobacco expenditure were subtracted from household income.

This is the first UK study to highlight the extent to which smoking exacerbates child poverty. The findings, published in the open access journal BMC Public Health, are based on national surveys which estimate the number of children living in poverty by household structure. In 1999, the UK government announced a target to abolish child poverty by 2020, though this target is unlikely to be met. It is therefore crucial to identify avoidable factors that contribute to and worsen child poverty.

The key finding of the Harvard study was that in 2014, 20.7% of current electronic cigarette users were former smokers. The important question, of course, is whether these represent ex-smokers who re-initiated nicotine use with e-cigarettes or whether these represent smokers who quit smoking using e-cigarettes and thus are now identified as former smokers who use e-cigarettes.

Deborah Arnott, Chief Executive of ASH

These data are consistent with a recent report from the UK which notes that during the past year alone, half a million smokers in the UK switched to e-cigarettes, and that most of these are ex-smokers, suggesting that these are smokers who quit smoking via the use of e-cigarettes.

“We’ve seen a steep decline in men drink-driving over the years, with targeted advertising campaigns, which is great, but women don’t seem to be getting the same message…

We would like to see a lower drink-drive limit, as most other European countries have, as well as Scotland, which saw a marked reduction in failed breathalyser tests as soon as the law was changed last year.”

Dr Leonie Brose, lead author of the first study, from the IoPPN at King’s College London, said: ‘E-cigarettes are still a relatively new product, so this study adds important information about what happens when they are used alongside tobacco cigarettes. We already know that using an e-cigarette in an attempt to quit smoking increases the chances of success compared to quitting without any support. This study did not test how helpful they are as quitting aids because we looked at smokers who were using them for any reason, including just to cut down on their smoking or in situations when they cannot smoke. But it is encouraging to see that even then, regular e-cigarette use was linked to reduced numbers of lethal cigarettes smoked and increased attempts to quit smoking in the following year.’

The second study extended this by looking at not only how often e-cigarettes were used but also what types were used, measured for the first time at follow up in 2013. E-cigarettes in the UK have been classified into two basic types – ‘cigalikes’ and ‘tank’ models. Cigalikes resemble tobacco cigarettes. They are disposable or use replaceable cartridges. Tank models look quite different from cigarettes and have containers that are refilled with the ‘e-liquid’.

In the second study the researchers found that of 587 people using e-cigarettes at the one year follow up, 76 per cent used cigalikes and 24 per cent used tank models. Nearly a third of daily tank users (28 per cent) had quit smoking compared with 13 per cent of those not using an e-cigarette. 11 per cent of daily cigalike users and 9 per cent of non-daily tank users had quit smoking, but these were not significantly different from those not using e-cigarettes.

Non-daily cigalike users were actually less likely to have quit compared with those not using e-cigarettes, with only 5 per cent having quit smoking. The researchers highlight this as a cause for concern because many of the most prominent brands of cigalikes in the UK are now owned by the tobacco industry. A recent study carried out at the IoPPN, funded by Cancer Research UK, found that tobacco industry cigalikes were the most prominent e-cigarettes at the point of sale in small shops.